I have read a lot on this, and I am pretty sure I have multiple myeloma. I will give test results from the last test done. I will be getting a bone marrow test January 26th. I think this is just testing to see what level and what kind?
IMMUNOFIXATION, SERUM
IgG kappa monoclonal band present
CBC (INCLUDES DIFF/PLT)
White Blood Cell Count 5.9 3.8-10.8 (Thousand/uL)
Red Blood Cell Count 3.89 L 4.33-5.82 (Million/uL)
Hemoglobin 13.1 L 13.7-17.7 (g/dL)
Hematocrit 39.4 L 41.5-53.8 (%)
MCV 101.3 H 80.0-100.0 (fL)
MCH 33.6 H 27.0-33.0 (pg)
MCHC 33.2 32.0-36.0 (g/dL)
RDW 13.2 11.0-15.0 (%)
Platelet Count 326 140-400 (Thousand/uL)
MPV 7.4 L 7.5-11.5 (fL)
Absolute Neutrophils 4207 1500-7800 (cells/uL)
Absolute Lymphocytes 1015 850-3900 (cells/uL)
Absolute Monocytes 507 200-950 (cells/uL)
Absolute Eosinophils 124 15-500 (cells/uL)
Absolute Basophils 47 0-200 (cells/uL)
Neutrophils 71.3 (%)
Lymphocytes 17.2 (%)
Monocytes 8.6 (%)
Eosinophils 2.1 (%)
Basophils 0.8 (%)
PROTEIN, TOTAL W/CREAT, RANDOM URINE
Creatinine, Random Urine 133 20-370 (mg/dL)
Protein/Creatinine Ratio 173 H 22-128 (mg/g creat)
Protein, Total, Random Ur 23 5-25 (mg/dL)
RENAL FUNCTION PANEL
Glucose 99 65-99 (mg/dL)
Urea Nitrogen (BUN) 20 7-25 (mg/dL)
Creatinine 1.35 H 0.70-1.33 (mg/dL)
For patients >49 years of age, the reference limit for
creatinine is approximately 13% higher for people
identified as African-American.
eGFR Non-Afr. American 57 L > OR = 60 (mL/min/1.73m2)
eGFR African American 66 > OR = 60 (mL/min/1.73m2)
BUN/Creatinine Ratio 15 6-22 ((calc))
Sodium 140 135-146 (mmol/L)
Potassium 4.7 3.5-5.3 (mmol/L)
Chloride 106 98-110 (mmol/L)
Carbon Dioxide 26 18-29 (mmol/L)
Calcium 9.4 8.6-10.3 (mg/dL)
Phosphate (As Phosphorus) 4.4 2.5-4.5 (mg/dL)
Albumin 4.5 3.6-5.1 (g/dL)
PROTEIN, TOTAL AND PROTEIN ELECTROPHORESIS
Protein, Total 6.6 6.1-8.1 (g/dL)
Albumin 4.3 3.8-4.8 (g/dL)
Alpha 1 Globulin 0.3 0.2-0.3 (g/dL)
Alpha 2 Globulin 0.6 0.5-0.9 (g/dL)
Beta 1 Globulin 0.3 L 0.4-0.6 (g/dL)
Beta 2 Globulin 0.3 0.2-0.5 (g/dL)
Gamma Globulin 0.7 L 0.8-1.7 (g/dL)
Abnormal Protein Band 1 0.2 H NONE DETECTED (g/dL)
Interpretation:
Faint restricted band (M-spike) migrating in the
gamma region. Consider serum immunofixation to rule
out a monoclonal protein if clinically indicated.
PTH, INTACT AND CALCIUM
Parathyroid Hormone, Intact 75 H 14-64 (pg/mL)
- Interpretive Guide Intact PTH Calcium
- Normal Parathyroid Normal Normal
- Hypoparathyroidism Low or Low Normal Low
- Hyperparathyroidism
- Primary Normal or High High
- Secondary High Normal or Low
- Tertiary High High
- Non-Parathyroid
- Hypercalcemia Low or Low Normal High
Calcium 9.4 8.6-10.3 (mg/dL)
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Re: IgG kappa monoclonal band - does it mean myeloma?
Hello Rolls,
You've got an M-spike of 0.2 g/dL and your serum immunofixation identifies the M-spike as being IgG kappa.
Someone who does not have multiple myeloma or MGUS (monoclonal gammopathy of undetermined significance) does not have an M-spike, and normally would not have the serum immunofixation pick up any monoclonal protein.
However, just because you have an M-spike, this does not mean you have multiple myeloma that requires treatment. The appropriate diagnosis may be smoldering multiple myeloma, or even MGUS, neither of which are typically treated.
For the diagnosis to be multiple myeloma requiring treatment, you would have to meet one of the "CRAB" criteria -- high Calcium levels, Renal (kidney) damage, Anemia, or Bone damage -- or you would have to have one of the three "myeloma defining events":
1. 60 percent or more clonal plasma cells in the bone marrow
2. Serum free light chain ratio of more than 100 (either kappa/lambda or lambda/kappa ratio)
3. At least two focal lesions bigger than 5 millimeters on an MRI study
Your calcium level is fine, as is your hemoglobin (which reflects whether or not you have anemia). You have an elevated creatinine level, suggesting that you have some kidney dysfunction, but the creatinine is not elevated enough to qualify as one of the CRAB criteria (it would have to be more than 2 for the Renal dysfunction criterion to be met).
Have you had your serum (blood) free light chain levels tested? If so, what were the results?
Also, have you had any x-rays or MRI done of your bones?
Based on the results you've shared so far, it doesn't really seem like you have multiple myeloma -- at least not the kind that requires treatment. It's probably either MGUS or perhaps smoldering myeloma.
But you will need more tests, especially the free light chain test, to determine your diagnosis.
Good luck, and let us know what results you get with any additional tests.
You've got an M-spike of 0.2 g/dL and your serum immunofixation identifies the M-spike as being IgG kappa.
Someone who does not have multiple myeloma or MGUS (monoclonal gammopathy of undetermined significance) does not have an M-spike, and normally would not have the serum immunofixation pick up any monoclonal protein.
However, just because you have an M-spike, this does not mean you have multiple myeloma that requires treatment. The appropriate diagnosis may be smoldering multiple myeloma, or even MGUS, neither of which are typically treated.
For the diagnosis to be multiple myeloma requiring treatment, you would have to meet one of the "CRAB" criteria -- high Calcium levels, Renal (kidney) damage, Anemia, or Bone damage -- or you would have to have one of the three "myeloma defining events":
1. 60 percent or more clonal plasma cells in the bone marrow
2. Serum free light chain ratio of more than 100 (either kappa/lambda or lambda/kappa ratio)
3. At least two focal lesions bigger than 5 millimeters on an MRI study
Your calcium level is fine, as is your hemoglobin (which reflects whether or not you have anemia). You have an elevated creatinine level, suggesting that you have some kidney dysfunction, but the creatinine is not elevated enough to qualify as one of the CRAB criteria (it would have to be more than 2 for the Renal dysfunction criterion to be met).
Have you had your serum (blood) free light chain levels tested? If so, what were the results?
Also, have you had any x-rays or MRI done of your bones?
Based on the results you've shared so far, it doesn't really seem like you have multiple myeloma -- at least not the kind that requires treatment. It's probably either MGUS or perhaps smoldering myeloma.
But you will need more tests, especially the free light chain test, to determine your diagnosis.
Good luck, and let us know what results you get with any additional tests.
Re: IgG kappa monoclonal band - does it mean myeloma?
Thanks for your response!
Here may be the test you are asking for:
Serum Kappa / Lambda Free Light Chains With Ratio
Kappa free light chain, serum - 26.1 H (3.3-19.4) (mg/L)
Lambda free light chain, serum - 12.7 5.7-26.3 (mg/L)
Kappa / lambda free light chain ratio, serum 2.06 H (0.26-1.65)
Note:
Free kappa/lambda ratio in serum of normal individuals is 0.26-1.65. Excess production of free kappa or lambda light chains alters the ratio. Ratios outside the normal range are attributed to the presence of monoclonal free light chains. Monoclonal free light chains are found in the serum of patients with multiple myeloma, Waldenstrom's macroglobulinemia, mu-heavy chain disease, primary amyloidosis, light chain deposition disease, monoclonal gammopathy of undetermined significance, and lymphoproliferative disorders. Measurement of free light chain concentration in serum is useful for diagnosis, prognosis,monitoring disease activity and following response to therapy of these disorders.
I also go in on the 26th of this month to get a bone marrow biopsy. I also have stage 3 chronic kidney disease, GFR 30-59 ml/min, and I have 19 stents and 2 bypasses to my heart.
Thanks again, I greatly appreciate your response.
Here may be the test you are asking for:
Serum Kappa / Lambda Free Light Chains With Ratio
Kappa free light chain, serum - 26.1 H (3.3-19.4) (mg/L)
Lambda free light chain, serum - 12.7 5.7-26.3 (mg/L)
Kappa / lambda free light chain ratio, serum 2.06 H (0.26-1.65)
Note:
Free kappa/lambda ratio in serum of normal individuals is 0.26-1.65. Excess production of free kappa or lambda light chains alters the ratio. Ratios outside the normal range are attributed to the presence of monoclonal free light chains. Monoclonal free light chains are found in the serum of patients with multiple myeloma, Waldenstrom's macroglobulinemia, mu-heavy chain disease, primary amyloidosis, light chain deposition disease, monoclonal gammopathy of undetermined significance, and lymphoproliferative disorders. Measurement of free light chain concentration in serum is useful for diagnosis, prognosis,monitoring disease activity and following response to therapy of these disorders.
I also go in on the 26th of this month to get a bone marrow biopsy. I also have stage 3 chronic kidney disease, GFR 30-59 ml/min, and I have 19 stents and 2 bypasses to my heart.
Thanks again, I greatly appreciate your response.
Re: IgG kappa monoclonal band - does it mean myeloma?
Hello Rolls,
The additional results you've shared are helpful.
Yes, you have an out-of-range free light chain ratio based on the standard "normal" range for the kappa-lambda free light chain ratio. However, because you have kidney impairment, your doctor really should be looking at a different "normal" range for the ratio, which is 0.37 - 3.10 instead of the usual 0.26 - 1.65.
Having kidney impairment causes different kappa and lambda serum free light chain results in everyone, whether or not you have MGUS or multiple myeloma. So the normal range for the kappa-lambda ratio is different for people with kidney (renal) impairment.
Have you had any x-rays or MRIs done and, if so, do they show any bone lesions?
If you have had x-rays or MRIs done, and they don't show any lesions, then I would say that you might have MGUS. However, it's even possible that the M-spike that was observed was transient, and that you may not even have persistent MGUS. Given your other medical conditions, I suspect that you are not in your 30s or 40s, which suggests that MGUS may be the more likely final diagnosis, since it becomes more likely as a person ages.
If you have had x-rays or MRIs done, and they don't show any bone lesions, then you may want to ask whether it's really necessary for you to have a bone marrow biopsy. There are different opinions on this subject, and there are people here in the forum whose opinions I respect a great deal who probably would say it's fine to have a bone marrow biopsy. There also is some difference of opinion on the subject among myeloma specialists. Dr. Kaufman at Emory says he always would do a bone marrow biopsy in situations such as yours,
https://myelomabeacon.org/forum/mgus-bone-marrow-biopsy-or-not-t3626.html#p20683
while Dr. Valent at the Cleveland Clinic says he probably wouldn't
https://myelomabeacon.org/forum/bone-marrow-biopsy-t1987.html#p10730
I would just discuss with your doctor whether she/he really feels it's necessary, and what the pros and cons would be.
If you want to read a recent forum discussion that got into the issue of whether or not to have a bone marrow biopsy, here's a link to one:
https://myelomabeacon.org/forum/initial-low-m-spike-gone-one-month-later-t8321.html
Good luck, and please keep us posted on what you find out. It helps everyone here learn more when we can find out what happens in cases such as yours.
The additional results you've shared are helpful.
Yes, you have an out-of-range free light chain ratio based on the standard "normal" range for the kappa-lambda free light chain ratio. However, because you have kidney impairment, your doctor really should be looking at a different "normal" range for the ratio, which is 0.37 - 3.10 instead of the usual 0.26 - 1.65.
Having kidney impairment causes different kappa and lambda serum free light chain results in everyone, whether or not you have MGUS or multiple myeloma. So the normal range for the kappa-lambda ratio is different for people with kidney (renal) impairment.
Have you had any x-rays or MRIs done and, if so, do they show any bone lesions?
If you have had x-rays or MRIs done, and they don't show any lesions, then I would say that you might have MGUS. However, it's even possible that the M-spike that was observed was transient, and that you may not even have persistent MGUS. Given your other medical conditions, I suspect that you are not in your 30s or 40s, which suggests that MGUS may be the more likely final diagnosis, since it becomes more likely as a person ages.
If you have had x-rays or MRIs done, and they don't show any bone lesions, then you may want to ask whether it's really necessary for you to have a bone marrow biopsy. There are different opinions on this subject, and there are people here in the forum whose opinions I respect a great deal who probably would say it's fine to have a bone marrow biopsy. There also is some difference of opinion on the subject among myeloma specialists. Dr. Kaufman at Emory says he always would do a bone marrow biopsy in situations such as yours,
https://myelomabeacon.org/forum/mgus-bone-marrow-biopsy-or-not-t3626.html#p20683
while Dr. Valent at the Cleveland Clinic says he probably wouldn't
https://myelomabeacon.org/forum/bone-marrow-biopsy-t1987.html#p10730
I would just discuss with your doctor whether she/he really feels it's necessary, and what the pros and cons would be.
If you want to read a recent forum discussion that got into the issue of whether or not to have a bone marrow biopsy, here's a link to one:
https://myelomabeacon.org/forum/initial-low-m-spike-gone-one-month-later-t8321.html
Good luck, and please keep us posted on what you find out. It helps everyone here learn more when we can find out what happens in cases such as yours.
Re: IgG kappa monoclonal band - does it mean myeloma?
Thanks again for responding to my post! I sometimes feel so alone with this as I am the only one doing all the research and still have to deal with the symptoms.
The reason I was given the test that my kidney gave was due to my symptoms. I have been so tired and fatigued and weak that I do not want to even get out of bed, which is not me at all. I am usually on the go all the time. Also, my feet, shoulders, and hips are hurting most all the time. It keeps me up through the night.
I also went to the ER about 2 months ago with a very lower back pain, so they did an x-ray and found nothing wrong in lower back. But they did say I have a fractured rib. The thing is, I have never done anything that would fractured my ribs.
I did look over the links you gave me, and since I will not know my true diagnosis without the bone marrow test, I need to get to the bottom of what is causing the pain, fatigue and tiredness. I am getting the bone marrow test the 26th of this month.
The abnormal protein the IgG kappa test coming out like they did.
Royce Spain
The reason I was given the test that my kidney gave was due to my symptoms. I have been so tired and fatigued and weak that I do not want to even get out of bed, which is not me at all. I am usually on the go all the time. Also, my feet, shoulders, and hips are hurting most all the time. It keeps me up through the night.
I also went to the ER about 2 months ago with a very lower back pain, so they did an x-ray and found nothing wrong in lower back. But they did say I have a fractured rib. The thing is, I have never done anything that would fractured my ribs.
I did look over the links you gave me, and since I will not know my true diagnosis without the bone marrow test, I need to get to the bottom of what is causing the pain, fatigue and tiredness. I am getting the bone marrow test the 26th of this month.
The abnormal protein the IgG kappa test coming out like they did.
Royce Spain
Re: IgG kappa monoclonal band - does it mean myeloma?
Hi Rolls,
Any update on this? How did your bone marrow test go?
Best wishes.
Any update on this? How did your bone marrow test go?
Best wishes.
Re: IgG kappa monoclonal band - does it mean myeloma?
HI Rolls,
You may want to ask about "monoclonal gammopathy of renal significance" (MGRS). After 2 years, 12 doctors, 2 head scans, kidney biopsy, and 2 hospital visits, I was diagnosed with this. There's not much on this (I've listed a key journal article and related Beacon article below). I had a number of doctors confused because my blood work was nothing they'd ever seen. My doctor said I'm his second patient to have this. My kidneys were not functioning correctly and causing me high blood pressure among other side affects.
We're on our second different type of chemo and that's not working, so I'm having another bone marrow biopsy Monday to find out why.
Keep pushing until you get answers if you haven't already.
Good luck,
Lisa
References:
Leung, N, et al, "Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant," Blood, 2012 (full text of article)
Myeloma Morning: Monoclonal Gammopathy Of Renal Significance (MGRS)," The Myeloma Beacon, April 25, 2016
You may want to ask about "monoclonal gammopathy of renal significance" (MGRS). After 2 years, 12 doctors, 2 head scans, kidney biopsy, and 2 hospital visits, I was diagnosed with this. There's not much on this (I've listed a key journal article and related Beacon article below). I had a number of doctors confused because my blood work was nothing they'd ever seen. My doctor said I'm his second patient to have this. My kidneys were not functioning correctly and causing me high blood pressure among other side affects.
We're on our second different type of chemo and that's not working, so I'm having another bone marrow biopsy Monday to find out why.
Keep pushing until you get answers if you haven't already.
Good luck,
Lisa
References:
Leung, N, et al, "Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant," Blood, 2012 (full text of article)
Myeloma Morning: Monoclonal Gammopathy Of Renal Significance (MGRS)," The Myeloma Beacon, April 25, 2016
-
Lisa Hogan
Re: IgG kappa monoclonal band - does it mean myeloma?
I have had another MRI and as of now am not showing bone lesions. Some things that were noted on the MRI that I was not sure how to interpret:
"No definite calvarial abnormalities identified. Just to the left of midline in the vertex of the skull there is a focal area of bright signal most consistent with a venous lake difficult to identify on prior exam likely due to differences in slice orientation" ?
"Some heterogeneity of marrow signal is present in the proximal femurs and bones of the pelvis without lytic abnormality detected."
My M spike has gone up from 0.2 to 0.6 g/dL, which worries me.
Thanks for your help.
Royce
"No definite calvarial abnormalities identified. Just to the left of midline in the vertex of the skull there is a focal area of bright signal most consistent with a venous lake difficult to identify on prior exam likely due to differences in slice orientation" ?
"Some heterogeneity of marrow signal is present in the proximal femurs and bones of the pelvis without lytic abnormality detected."
My M spike has gone up from 0.2 to 0.6 g/dL, which worries me.
Thanks for your help.
Royce
Re: IgG kappa monoclonal band - does it mean myeloma?
Hello rolls1957,
I would not draw any conclusions from the change in M-spike from one test to another. There's uncertainty when measuring an M-spike, and results can also differ from one lab to another.
The MRI results that you quote simply indicate that the radiologists noted areas that might look, at first glance, like they are myeloma-related, but they are not on closer examination. In the skull, for example, there are areas known as "venous lakes" that look similar to lytic lesions unless you examine the image carefully (or do a biopsy). Also, the second statement you quoted explicitly states that no lytic abnormality (lesion) was found.
You should be okay if you continue to get your blood tested regularly so that you can watch your M-spike, free light chain levels, and other key markers (hemoglobin, creatinine, calcium, and immunoglobulin levels). If you haven't already done so, start a folder where you can store all the results so you can find them quickly, and write down (or enter into a spreadsheet) the key numbers so you can find and review them easily. As I already mentioned, you want to look for trends, especially trends that are reflected in more than one set of results.
How frequently are you currently getting blood tests to measure your M-spike, free light chains, and the like?
Good luck!
I would not draw any conclusions from the change in M-spike from one test to another. There's uncertainty when measuring an M-spike, and results can also differ from one lab to another.
The MRI results that you quote simply indicate that the radiologists noted areas that might look, at first glance, like they are myeloma-related, but they are not on closer examination. In the skull, for example, there are areas known as "venous lakes" that look similar to lytic lesions unless you examine the image carefully (or do a biopsy). Also, the second statement you quoted explicitly states that no lytic abnormality (lesion) was found.
You should be okay if you continue to get your blood tested regularly so that you can watch your M-spike, free light chain levels, and other key markers (hemoglobin, creatinine, calcium, and immunoglobulin levels). If you haven't already done so, start a folder where you can store all the results so you can find them quickly, and write down (or enter into a spreadsheet) the key numbers so you can find and review them easily. As I already mentioned, you want to look for trends, especially trends that are reflected in more than one set of results.
How frequently are you currently getting blood tests to measure your M-spike, free light chains, and the like?
Good luck!
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